Developmental MilestonesIs your child developing normally?

Whether you are a first-time parent or have a house full of children, it is common to wonder if your child is developing normally. It can be hard to avoid comparing your child to others. Maybe your niece walked earlier than expected as a toddler, while Timmy down the block is two but still not talking. Once your child is in school, teachers’ reports can give you a better idea of how your child is developing compared to others her age. How can you know what is considered normal before kindergarten? Being aware of certain milestones will help you to monitor your child’s development, while watching for red flag warning signs.

Domains of development

Child skill development is often divided into several different categories or ‘domains.’

Fine motor skills involve manipulating objects with the hands and fingers - picking up a toy, feeding oneself or using a pencil.

Language skills are divided into two parts:

expressive language refers to sounds and words your child makes.

receptive language involves listening skills, and includes your child’s reaction to and understanding of sounds and words.

Social skills include smiling, emotions, eye contact, interest in other people, and how your child plays with toys and with others.

Adaptive skills include everyday life skills such as dressing, toilet training, bathing, and feeding oneself. In the early stages, when babies are not expected to do all of these things, adaptive skills may just mean how your baby lets you know what he needs to be happy.

What are milestones?

When first born, we are not immediately able to do things that we can do as adults. Children develop slowly and learn skills as they grow. Studies of infants and children have helped us document milestones – skills that at least half of all children can do by a certain age (see table below).

Normal Developmental Milestones

Age

Gross Motor

Fine Motor

Expressive Language

Receptive Language

Social and Adaptive Skills

6 weeks

Can lift chin while
on tummy

Hands are in fists near the face most of the time

Makes sounds other than crying

Startles to a loud noise

Smiles, particularly at caregivers

2 months

While on tummy, props head and chest up with arms, head will bob if held in a sitting position

Holds rattle if placed in hand

Cooing and vowel-like noises (a, e, i, o, u)

Appears alert to voice or sound

Responds to adult voices and smiles

4 months

Rolls front to back when lying down, holds head still when supported in sitting position

Reaches for objects and clutches at clothes, holds hands open most of the time

Can dress and undress fully, shares without being told, uses imaginative and pretend play with others

4 years

Hops on one foot – two to three times, jumps one to two feet from standing

Copies a square, ties a single knot, uses fork well

300 to 1000 words, repeats four to six syllable sentence, strangers can understand nearly all of what child is saying

Follows three step commands, names things when the action or function is described – ‘It tells time, you cut with it, it swims in the water,’ reads common words (street or store signs)

Plays in a group, interested in tricking others, goes to the toilet alone, washes hands

5 years

Skips, jumps backwards, walks backward heel to toe

Copies triangle, cuts well with scissors, writes first name

Responds to “why” questions, retells stories with clear beginning, middle and end

Knows right and left on self, enjoys rhyming words

Has a group of friends, apologizes for mistakes

What if my child does not have some of these milestones?

If your child has not reached a certain milestone yet, there is no need to panic! Milestone charts are not perfect and every child develops at a slightly different rate. Many children are a little bit behind in one or two skill domains. Remember, milestones are often based on the point at which half of all children of that age can perform a certain skill. The other half includes many who are developing normally but need a bit more time and practice to achieve that milestone. However, if you are ever worried, take your child for an assessment by your family doctor.

What if my baby was born prematurely?

When a baby is born very early, the expectations for milestone development often change. This means that it may be normal for your premature baby to be a little bit late in achieving skill milestones. After all, we cannot expect a baby who was born two months early to reach the same early milestone as babies who were born full term. Childhood development is not an exact science.

Doctors still do not agree on how long we should correct our expectations for premature babies. One rule of thumb is to correct for prematurity until a baby reaches his second birthday. Then after two years, a baby’s development should be the same as other children.

Red flag warning signs

Parents often worry about autism or other developmental delays. Certain early warning signs should alert you to go to the doctor to check on your child’s development.

Your child is many months behind on a skill domain, or consistently behind on a skill domain.

Your child is behind in many skill domains.

Your child seems to have lost skills (also called regressing) at any age.

You have concerns about your child’s language skills – for instance, if your child is not babbling by nine months of age, pointing or using gestures by 12 months, or using single words by 16 months.

You have concerns about your child’s social skills – for instance, if your child uses less eye contact than other children the same age, does not respond well to her name by 12 months of age, or does not take part in pretend or symbolic play (like drinking from an imaginary cup) by 18 months of age.

One of the best ways you can monitor development is to take your child to your family doctor for regular check-ups. This means a check-up every two to three months in the first year of life, every six months from 12 months to two years old, and then every year from ages two to eight. Most children develop normally, even if they are behind on a milestone or two every so often. If you are worried about your child’s development or see some red flags, schedule an appointment with your doctor, even if it is not time for your child’s regular check-up.